Health-and-Nutrition/C2/Hand-expression-of-breastmilk/English

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Visual Cue
Narration
Slide Number 1

Title Slide

Welcome to the Spoken Tutorial on hand expression of breastmilk.
Image: Woman feeding breastmilk to a baby from a cup

GIF: Mother expressing breastmilk with her hand.

Image: Multiple pictures of mother expressing breastmilk

In this tutorial we will learn,
  • Benefits of expressing breastmilk
  • How to express breastmilk by hand and
  • How often should a mother express breastmilk
Image: Mother is expressing her breastmilk by hand.

GIF: Mother expressing breastmilk

Image: Mother with engorged breasts.

Breastmilk expression is useful to:
  • Relieve breast engorgement;
Image: Dry, sore and cracked nipples.

Image: Sore and cracked nipple

  • To treat nipple soreness and dry skin on the dark area around the nipple;
Image: Mother in pain

Image: sore nipple

  • To feed a baby if mother’s sore nipple is extremely painful while latching
GIF: Mother’s breastmilk supply increasing
  • To increase or maintain mother’s breastmilk supply;
Image: Working mother
  • To keep breastmilk available for a baby when the mother goes out or to work;

Image: Full breast

Image: Baby trying to attach to a full breast

  • To help a baby to attach to a full breast by softening the dark area around the nipple;

Image: Foremilk.

Image: Hindmilk.

Image: Mother breastfeeding from right breast

Image: Mother offering left breast to the baby.

Image: Empty breast and breast full of milk.

  • To check whether the baby has fed from one breast completely before offering the other breast.
Image: Bowl of complementary food with water added to it.

Image: Bowl of complementary food with breastmilk added to it.

Image: More than sign. (>)

  • To make nutritious complementary food for a baby by using breastmilk instead of water or cow’s milk
Image: Premature baby

Image: Sick baby

Image: Baby with poor muscle tone

Image: Baby with cleft lip

Image: Baby with cleft palate

Image: Baby is unable to latch deeply to the breast

  • And to help in feeding milk to -
    • Premature babies
    • Sick babies
    • Babies with poor muscle tone
    • Babies with cleft lip and/or palate and
    • Babies who have difficulty in latching deeply to the breast
GIF: Mother expressing breastmilk Now, let’s learn how to express breastmilk.
Image: Mother expressing breastmilk by hand The most recommended way for a mother to express breastmilk is by using her hand.
Image: Red nipple and areola after expressing breastmilk Because this method causes less discomfort to the dark area around the nipple.
Image: breast pump
  • Also, this method needs no appliance.
  • So the mother can do it anywhere and at any time.
Image: Mother is practising expression of breastmilk. Expressing breastmilk by hand is a learned skill and will improve with practice.
Image: Soft breasts. It is easy to hand express breast milk when the breasts are soft.
Image: 1st and 2nd day after delivery.

Image: Calendar

Therefore, a mother should learn this skill on the first or second day after delivery.

Image: Wide mouth steel container

Image: Wide mouth glass container

Before expressing breastmilk,

Mother should have a steel or glass container ready to collect the expressed milk.

Image: Wide mouth cup

Image: Wide mouth glass

Image: Wide mouth jug

Image: Wide mouth jar

She should choose a cup, glass, jug or jar with a wide mouth.
Image: Mother is washing a wide mouth cup with soap and water She should wash the chosen container with soap and water.
Image: Cup is kept in boiling water

Image: Mother is pouring boiling water in the container

Image: Clock showing 10 minutes

After that, she should either -
  • keep the container in boiling water or
  • pour boiling water into the container and leave it for a few minutes.
Image: Cup is air-dried completely Then, she should either
  • air dry the container completely
  • Or wipe it dry with an unused clean cloth

The container should never be dried with a used cloth such as a used kitchen cloth.

Image: Inside of the breast showing breastmilk release from the tissues in the ducts After the clean container is dried completely, next step is to release breastmilk from the breast.
Image: Mother is relaxing with the baby To help her milk flow, the mother should feel relaxed and emotionally connected to her baby.
Image: Mother is sitting quietly and privately

Image: Mother is sitting with a supportive friend

Mother can try the following:
  • She can sit quietly and privately or with a supportive friend.
Image: Mother is sitting with other mothers.
  • Some mothers can express easily in a group of other mothers who are also expressing breastmilk.
Image: Skin-to-skin contact between mother and child
  • She can hold her baby on her lap with skin-to-skin contact.
Image: Mother is looking at the baby

Image: Mother is listening to the baby’s voice.

Image: Mother is listening to her baby’s voice on phone.

  • Or she can look at her baby or hear her baby’s voice.
Image: Mother is looking at baby’s photograph

Image: Mother is smelling baby’s blanket and clothing

Sometimes-
  • even looking at a photograph of her baby or smelling her baby’s clothing helps.
Image: Mother is drinking a hot drink from a cup

Image: Tea

Image: coffee

Image: alcohol

  • She can take a warm soothing drink.
  • But, the drink should not be coffee, strong tea, alcohol or any stimulant.
Image: Mother is applying warm compress on breasts

Image: Mother is taking a warm water bath

  • She can also warm her breasts to help her milk flow.
  • To warm her breasts, she can-
    • apply a cloth soaked in hot water to her breasts,
    • or have a warm water bath.
Image: Mother is gently pulling or rolling her nipple and areola She can stimulate her nipples and the dark area around them by-
  • gently pulling
  • or rolling them with her fingers.
Image: Mother is massaging her breasts using circular movements She can massage her breasts lightly using circular movements.
Image: Helper is rubbing mother’s back Mother can ask a helper to rub her back.
Image: Mother is sitting. Helper is standing close to her.

Image: Mother is leaning forward. Helper is standing close to her.

Image: Mother has folded her arms on a table in front of her. Her head is on her arms.

For the back rub, the mother should-
  • sit down,
  • lean forward,
  • fold her arms on a table in front of her and
  • rest her head on her arms.
Image: Mother’s breasts are unclothed and hanging loose Her breasts should be unclothed and hanging loose.
Image: Helper is rubbing down both sides of mother’s spine. The helper should rub down both sides of the mother's spine.
Image: Helper’s fist is closed with thumbs pointing forward. She should use her closed fist with her thumbs pointing forward.
GIF: Helper massaging mother’s back She should press firmly making small circular movements with her thumbs.
GIF: Helper is massaging mother’s back.

Image: 2-3 minutes clock

She should work down both sides of the spine at the same time from the neck to the shoulder blades.

She should do this for two or three minutes.

Image: Oxytocin reflex All these steps will help in releasing the breastmilk.

This release of breastmilk is called Oxytocin reflex or let down reflex.

Image: Mother washing her hands.

Image: Mother showing her dry and clean hands.

After the oxytocin reflex begins, the mother must wash and dry her hands thoroughly.
Image: Mother is sitting comfortably Then, the mother should sit comfortably.
Image: Mother is leaning forward slightly She should lean forward slightly.
Image: Mother is holding the container with her left hand near her right breast She should hold the container near her breast.
Image: Mother has placed her right thumb and fingers on her right breast in a C shape hold from the side.

Image: C shape hold

Now, she should place her thumb and fingers on the breast in a C shape hold from the side.
Image: Mother is using left hand to hold her right breast in C shape hold.

Image: Mother is using her right hand to hold her left breast in C shape hold

Image: Mother switches from her right to her left for holding her right breast in C shape hold.

  • She can use either hand for holding either breast.
  • And she can switch to the other hand when the first one tires.
Image: Highlight mother’s right thumb on the upper part of the right breast While holding the breast, her thumb should be on the upper part of the breast.
Image: Highlight mother’s fingers on the lower part of the breast And her fingers should be placed opposite to the thumb on the lower part of the breast.
Image: Mother’s right thumb, nipple and fingers are in a straight line. Nipple is in the centre. Her thumb, nipple and fingers should always be in a straight line.
Image: Nipple is in the middle of the thumb and the index finger And the nipple should be in the middle of the thumb and the index finger.
Image: Distance of 2 fingers between the nipple and her thumb

Image: Distance of 2 fingers between nipple and mother’s fingers

There should be a distance of 2 fingers between-
  • the nipple and her thumb and
  • the nipple and her fingers.
Image: Mother’s thumb and fingers very close to the nipple and pinching it. Very less milk is coming out. If the fingers are too close to the nipple, the milk may not flow for long.
Image: Mother’s thumb and fingers are at a distance of 2 fingers from the nipple.

Image: More milk is coming out from the milk ducts beneath the areola.

Image: Milk flowing inside the breast.

Mother will release more milk when-
  • she compresses the milk ducts beneath the dark area around the nipple.
Image: Mother is holding her right breast in a C shape hold with her right hand In this picture, the mother is holding her right breast correctly with her right hand.
Image: Mother is pressing the breast slightly inwards towards her chest wall by applying steady pressure. Now, she should -

Press the breast slightly inwards towards the chest wall by applying steady pressure.

Image: In that pressed position, without moving the hand, mother is gently compressing the breast between the thumb and fingers. Then, without moving the hand -

gently compress the breast between the thumb and the fingers.

Image: Mother releases the pressure on the breast and comes to the starting position. And then, release the pressure on the breast.
Image: All 3 steps together

GIF: Mother is expressing breastmilk in these 3 steps

The mother should repeat these 3 steps-
  • Press back
  • Compress
  • And release.
GIF: Mother is pressing the breast slightly inwards towards the chest wall The first step of pressing back towards the chest wall is an important step.
GIF: Mother is pressing towards the nipple and very little milk is released. Pressing only towards the nipple will give very little milk.
GIF: Correct expression technique and more milk is released. But when the breast is pressed back, milk from the dense breast tissue is released.
GIF: Mother is pressing too far back and too hard

Image: Blocked milk ducts

But, avoid pressing too far back, because that can block the milk ducts.
GIF: Mother is expressing milk the right way but only a few drops come out. When the mother starts expressing breastmilk by hand, very few drops of milk may come out at first.
Image: Let down reflex

Image: Mother is still expressing breast milk and milk is dripping out.

As the let down reflex starts, milk starts to drip out.
GIF: Mother is expressing breastmilk and milk is dripping out slowly

GIF: Mother is expressing milk and milk flows in streams

Image: Mother’s confidence increases when she breastfeeds for a long time.

Image: Mother’s confident increases when she expresses breastmilk for a few days.

  • In the first few attempts, it is common for the milk to drip out or come slowly.
  • Later, breastmilk may flow in streams.
  • As with breastfeeding, expressing breastmilk is a skill that comes with practice.
Image: Few drops of colostrum coming out of mother’s breast when she is expressing breastmilk

Image: Colostrum protects the baby from diseases

  • Colostrum, the first milk after birth, may only come in drops but is enough for the newborn.
  • The thick, often yellow milk, has enormous protective benefits for the baby.
Image: Step 1 of hand expression. Mother is pushing her breast back towards the chest.

Image: Step 2 of hand expression. Mother is pressing the breast.

Image: Step 3 of hand expression. Mother has released the pressure.

Image: Breastmilk flows in a drip

The mother should repeat the 3 steps until the flow of milk slows down to a drip again.
Image: Mother is holding the breast in U shape hold


Then, she should reposition her fingers to express milk from other parts of the breast.
Image: Mother checking the breast for fullness and compressing. She can feel for where the breast seems fuller, and compress those areas.
Image: Clock 3-5 minutes

Image: Milk flow slows down

She should express milk from one breast for at least 3 to 5 minutes until the milk flow slows down.
Image: Mother is expressing milk from the other breast Then, she should express milk from the other breast in the same way from all the areas.
Image: Mother is expressing milk from both breasts again And then again express milk from both breasts a second time.
Image: clock showing 20-30 minutes

Image: clock showing 45 mins

Image: Expression in first few days

Image: 5-10 minutes clock

  • Expressing breastmilk from both breasts adequately takes 20 to 30 minutes.
  • It may take more time, especially in the first few days
  • As in those days, only a little milk may be produced.
  • It is important not to try to express in a shorter time.
Image: Mother is feeling the pain while expressing milk

Image: Cross mark

Remember,
  • Expressing breastmilk by hand should not hurt.
  • If it hurts, the technique is wrong.
Image: Breast tissue

Image: Mother is rubbing fingers towards nipple.

Image: Sliding

Image: Pulling

Image: Breast soreness

  • Breast tissue is delicate.
  • Avoid rubbing, sliding or pulling the fingers along the skin, towards the nipple.
  • This can cause breast soreness.
Image: Tightening or stretching the skin over areola Avoid tightening or stretching the skin over the dark area around the nipple.
Image: Pulling the nipple

Image: Less milk comes out when mother presses the nipple

Image: Baby is nipple-feeding

  • Also, avoid squeezing or pulling the nipple.
  • Pressing or pulling the nipple cannot express enough milk.
  • It is the same as the baby sucking only the nipple.
Image: Container covered with cloth

Image: Container covered with plate

After expressing breastmilk, the mother should cover the container with a clean cloth or plate.
Image: Container is stored safely in fridge

Image: Container is stored safely in the room

Then, she should store her breastmilk safely for later use.

Safe storage of breastmilk and feeding stored breastmilk to the baby are explained in another tutorial.

Image: Mother expressing breastmilk multiple times in a day

Image: Initiating and maintaining breastmilk production

Image: Milk supply in a container

Image: Low birth weight baby

Image: Sick newborn baby

Image: Mother is expressing breastmilk within 6 hours after delivery

Let’s now discuss how often a mother should express milk.

If the purpose is to initiate and maintain breastmilk production

Or to feed a low birth weight baby or sick newborn baby, then-

  • She should express milk as soon as possible after delivery.
Image: Mother is expressing few drops of colostrum

Image: Breastmilk production begins

Image: Baby breastfeeding in the delivery room in laid back hold.

  • She may only express a few drops of colostrum at first.
  • This helps breastmilk production to begin
  • It acts similar to a baby suckling soon after delivery.
Image: Mother is expressing breastmilk as often as baby breastfeeds

Image: Mother is expressing breastmilk every 3 hours for 24 hours

Image: Mother is expressing breastmilk after 3 hours. Breastmilk output is low.

  • The mother should express as much as she can
  • And as often as her baby would breastfeed.
  • This should be at least every 2 to 3 hours, including during the night.
  • If there are long intervals between expressions, she may not be able to produce enough milk.
Image: Mother’s milk supply is increasing from 350ml to 850ml. Mother is happy.

Image: Mother’s milk supply is low 350ml. She is sad.

Image: Mother is breastfeeding the baby every 1-2 hours.

Image: Immediately after breastfeeding, mother is expressing breastmilk.

Image: Baby is sleeping for more than 3 hours.

Image: Mother is expressing milk between 2 breastfeeding sessions.

Next, if the purpose is to build up mother’s milk supply -

And if it seems to be decreasing after a few weeks:

  • She should express breastmilk every 1 to 2 hours immediately after breastfeeding the baby and
  • If the baby is expected to sleep for more than 3 hours, then she can express in between feeds.
Image: Breast engorgement

Image: Leaking of breastmilk at work

Image: Mother expressing breastmilk

Image: Mother gets relief from breast engorgement

Image: Leaking of breastmilk at work stops

If the purpose is to relieve symptoms such as engorgement, or leaking of breastmilk at work:
  • The mother should express only as much as is necessary.
Image: Mother is expressing a small drop of breastmilk.

Image: Mother is rubbing the small drop of breastmilk on her nipple.

Image: Mother is bathing.

Image: Mother is breastfeeding.

If the purpose is to keep nipple skin healthy:
  • The mother should express a small drop of breastmilk to rub on her nipple.
  • She should do this after a bath and after breastfeeding.
Image: Mother is working

Image: Father is feeding milk to the baby from a small cup

Image: Mother is expressing milk at work

Image: Mother is expressing milk at home

Image: Mother gives the expressed milk to father who is holding the baby

If the purpose is to keep milk for her baby while the mother is out at work:
  • The mother should express milk while at work to help keep up the supply.
  • And the mother should express breastmilk before going to work
    • and leave it for the carer to give to the baby.
Image: Refrigerator

Image: Expressed breastmilk stored in fridge

Image: Mother is expressing breastmilk after feeding the baby

Image: 60-90 ml expressed breastmilk

Image: Father is adding more milk than 90 ml to the container for feeding the baby

Image: Mother is at work

For doing this -
  • Mother can plan few weeks ahead if she has a fridge.
  • She can express extra milk and store it for later use.
  • Mother can express even after the baby has breastfed.
  • Mother should leave about 60 to 90 milliliters of milk for each feed
  • More breastmilk can be given as per baby’s need while mother is away.
Image: Mother is expressing breastmilk more often

Image: Mother is comfortable while expressing

Image: Milk is flowing from the tissues to the milk ducts beneath areola

Image: Mother is producing more milk 750 ml

Remember,
  • The more frequent hand expression is used-
    • the easier it becomes to express milk,
    • the faster the milk releases
    • And the more milk mother will make.
Slide Number 2

Acknowledgement

This brings us to the end of this tutorial.

Thank you for joining.

Contributors and Content Editors

Bellatony911, Tasneemiitb